For many Americans, a hospital visit is a scary proposition. Paying for it could be even scarier.
Hospitals billed an average of $56,610 for an inpatient stay in 2019, according to data from the Healthcare Cost and Utilization Project. While insurance coverage can reduce your portion of a bill by a large margin, you’ll undoubtedly be responsible for some of the costs of your stay. Those costs will vary widely depending on the type of treatment you need and the facility itself.
Whether you’re breezing through a hospital’s outpatient department for a routine test or preparing for a longer, more complicated stay, a bigger bill doesn’t necessarily translate to better care. It’s possible to minimize your financial burden, avoid unnecessary costs and give yourself some peace of mind.
The first step? Planning.
“It's really important to spend an hour or two thinking about the financial aspects in advance,” says Patricia Kelmar, the healthcare campaigns director at US PIRG, a public interest advocacy group.
There are also steps you can take over the course of a hospital stay and afterwards to minimize the impact to your pocketbook and make sure you’re getting the highest-value, best-quality care for your money — even if you find yourself in the emergency room dealing with an unexpected crisis.
Read below for everything you need to know and check out Money's Best Hospitals picks, too.
Before your stay
Understand your insurance
One of the biggest factors that will impact the cost of your hospital stay is your insurance plan. It’s vital that you do some research in advance of your stay to determine exactly what your plan will cover and how much of the total cost of care you’ll be expected to pay out of pocket. Have you met your deductible for the year? Will you be responsible for a co-pay?
And critically: is the hospital and doctor you’ll be seeing in your insurance network? Opting for in-network providers (meaning that your insurance company has already negotiated a price agreement with the doctor’s office or hospital) is one of the best ways to maximize the insurance coverage you likely already pay for. “You’ll pay a lot more of [the cost] of your care,” Kelmar says, “if you choose an out of network hospital.”
If you don’t have insurance, look into your options for coverage
Caitlin Donovan, spokesperson for the National Patient Advocate Foundation, says the first thing she recommends for uninsured patients preparing for a hospital stay is to enroll in some type of health plan. Are you eligible for Medicaid or Medicare? Does your employer offer benefits? If that isn’t feasible, you have other options too. Many hospitals have financial assistance programs for low-income and uninsured patients, and you can also inquire about discounted rates in advance.
Be diligent about prior authorizations and referral requirements
Sometimes, insurance companies will require you to get permission in advance before they will agree to cover certain procedures or hospital stays. They could also require a referral from your regular doctor before they agree to cover the cost of a visit with a specialist.
If you aren’t aware of these requirements or fail to fulfill them, your coverage may be denied and you could be “on the hook for a lot of money,” Donovan says. A hip replacement surgery can cost upwards of $40,000, but a patient with insurance coverage could end up paying less than 10% of that cost out of pocket, depending on their plan.
And even if your doctor assures you that you don’t need a prior authorization letter, Kelmar recommends calling your insurance company to double check. That phone call alone could save you tens of thousands of dollars.
Know the law
A new law called the No Surprises Act went into effect at the beginning of this year. The legislation is designed to prevent consumers insured by private companies from receiving surprise medical bills from out-of-network providers. It would protect you from a massive bill if the anesthesiologist who assisted with your hip replacement wasn’t covered by your insurance even though the surgeon and hospital were both in-network, for instance.
The new rules apply to emergency room care, plus care at in-network facilities and air ambulance transportation. There’s also a long list of exceptions, including regular ground ambulances and care received at facilities other than emergency rooms and in-network hospitals and ambulatory surgery centers. You’re also still responsible for all your regular in-network costs.
Get a cost estimate
If you won’t be using insurance for a medical procedure, the No Surprises Act requires your doctor or hospital to provide a “good faith estimate” of the cost of the treatment. If your bill ends up being $400 or more higher than the estimate, you’ll be able to dispute it.
Getting a cost estimate is a good idea even if you’re planning on using insurance for a procedure or hospital stay. If your hospital can’t provide one, resources like Healthcare Bluebook, Fair Health, Guroo and others can help you compare costs for different procedures so you know what to expect.
Remember the “little” things
The cost of your treatment isn’t the only hospital expense you’ll need to plan for. Will you need to pay for parking or transportation? Childcare or a dog sitter? Will a caregiver need a hotel room nearby, or will they be buying meals from the hospital cafeteria? Will you need to take time off work? All those extra costs can add up quickly — make sure you factor them into your budget.
During your stay
Bring an advocate with you
It’s always helpful to have backup, especially during a stressful situation like a hospital stay. Consider bringing a companion with you who can help with the logistics so you can focus on your health. This person can take notes about the care you receive and keep track of medication and provider schedules. They can also spot mistakes before they happen and make sure you have everything you need to make your visit as smooth — and speedy — as possible.
Hospitals can be hectic, and providers can make mistakes. That’s why it’s important to stay engaged with your care and ask questions when necessary. The answers could make a big difference in your overall health and in your final bill.
Is the specialist at your door part of your insurance network? Is that daily blood test really necessary? Could you spend less by switching to a shared room? Is that unfamiliar pill the correct medication? A companion can help you with this, too.
After your stay
Ask for an itemized bill
Make sure to check your bill for accuracy when you receive it. If the bill you receive isn’t itemized, ask for a version that breaks down the charges in detail. This will help you compare the charges with your insurance plan’s explanation of benefits and spot mistakes. Did the hospital charge you for medication you brought with you? Did they charge you for the correct number of nights?
And don’t be surprised if you receive a series of bills over time. Depending on the facility, different providers (like the surgeon, anesthesiologist and others) might send different bills at different times. Kelmar says it’s common for patients to not know what they owe for a couple of months after a hospital visit.
Try to negotiate
If your bill is more than you can pay when it arrives, it’s always a good idea to get in touch with the hospital’s billing department. “Most of the time, you can at least negotiate down if you get a big bill,” Donovan says. If the hospital won’t negotiate on price, you have other options. Can they put you on a monthly payment plan? Will they give you a discount for paying in cash? Do you qualify for any assistance?
“Explain your financial situation,” Kelmar says. “Tell them what you can manage and work with them. It's always worth it to do it.”
Avoid credit card payments
If you can’t afford to pay what you owe in full, be cautious about charging the balance to your credit card — especially if you have any doubts that you’ll be able to pay the balance off right away. “A credit card interest rate is very, very high,” Kelmar warns. If you can, she recommends working out a payment plan directly with the hospital instead. You’ll get a better interest rate and you could avoid late fees.
You’ll also preserve some flexibility when it comes to the final bill. “Once the provider is paid because you paid on your credit card,” Kelmar says, “there’s no more negotiating.”
Keep up with your annual appointments
If you can access care like annual physicals, dentist appointments and other preventative screenings without breaking the bank, it’s never a bad idea. Insurance plans generally cover these, and you can also take advantage of resources like free clinics if you don’t have insurance. Staying on top of your health before problems arise is the best way to avoid complications and costly hospital stays down the road.
“It's the prevention that keeps you healthier,” Kelmar says, “and keeps those costs from going way up.”
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